Ma KP, Fu JX, Duan F, Wang MQ. Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma. World J Gastrointest Oncol 2024; 16(4): 1236-1247 [PMID: 38660650 DOI: 10.4251/wjgo.v16.i4.1236]
Corresponding Author of This Article
Mao-Qiang Wang, MD, PhD, Deputy Director, Department of Interventional Radiology, The Fifth Medical Center of Chinese People's Liberation Army General Hospital, No. 28 Fuxin Road, Haidian District, Beijing 100853, China. wangmaoqiang301@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Apr 15, 2024; 16(4): 1236-1247 Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1236
Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma
Kun-Peng Ma, Jin-Xin Fu, Feng Duan, Mao-Qiang Wang
Kun-Peng Ma, Jin-Xin Fu, Feng Duan, Mao-Qiang Wang, Department of Interventional Radiology, The Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China
Kun-Peng Ma, Chinese People's Liberation Army Medical School, Beijing 100853, China
Author contributions: Wang MQ contributed to the conception and design; Ma KP and Fu JX contributed to the analysis and interpretation of data; Ma KP and Duan F contributed to the writing, review, and/or revision of the manuscript; All authors contributed to the acquisition of data (acquired and managed patients) and final approved the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Chinese People's Liberation Army General Hospital.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
Data sharing statement: The authors declare that all data and materials supporting the findings of this study are available within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mao-Qiang Wang, MD, PhD, Deputy Director, Department of Interventional Radiology, The Fifth Medical Center of Chinese People's Liberation Army General Hospital, No. 28 Fuxin Road, Haidian District, Beijing 100853, China. wangmaoqiang301@163.com
Received: October 4, 2023 Peer-review started: October 4, 2023 First decision: December 18, 2023 Revised: December 29, 2023 Accepted: February 18, 2024 Article in press: February 18, 2024 Published online: April 15, 2024 Processing time: 189 Days and 12.9 Hours
ARTICLE HIGHLIGHTS
Research background
Transarterial chemoembolization (TACE) is the standard locoregional therapy for unresectable hepatocellular carcinoma (HCC), but not every patient can benefit from TACE, and there is also relatively high post-TACE recurrence. Triple therapy with TACE combined with lenvatinib plus PD-1 inhibitors, may result in a better prognosis for HCC patients.
Research motivation
The efficacy and safety of this triple therapy have been rarely evaluated and it is unknown which factors are related to efficacy. By solving this problem, this will aid clinical decision-making.
Research objectives
In this study, we aimed to first assess the efficacy and safety of TACE-lenvatinib-PD1 therapy for unresectable HCC patients and to explore the predictive factors of clinical outcomes.
Research methods
During follow-up, tumor responses were assessed based on the modified Response Evaluation Criteria in Solid Tumors and categorized as complete response, partial response, stable disease, or progression disease. The objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS) were also calculated. The Cox proportional hazards regression method was used to identify the factors associated with OS and PFS.
Research results
The confirmed ORR was 61.76% (63/102), and the DCR was 81.37% (83/102). The median PFS was 10.07 months (95%CI: 8.50-11.65), and the median OS was 26.43 months (95%CI: 17.00-35.87). Barcelona Clinic Liver Cancer Classification (BCLC) B stage, early neutrophil-to-lymphocyte ratio (NLR) response (decrease) and early AFP response (decrease > 20%) were identified as the independent predictors of clinical outcomes.
Research conclusions
This study showed that TACE-lenvatinib-PD-1 treatment was well tolerated with encouraging efficacy in unresectable HCC patients. The patients with BCLC B, with early NLR response (decrease) and early AFP response (decrease > 20%) might achieve better clinical outcomes with this triple therapy.
Research perspectives
Further prospective studies with larger sample sizes are necessary. In addition, subgroup analyses are needed to determine the unknown differences attributing to each agent.
